On January 1, 2010, new health care reforms to help consumers will go into effect. This new law (Chapter 237 of 2009) will further bolster protections, expand consumer access and guarantee timely payments to providers.

The law, sponsored by Assemblywoman Sandy Galef, will modify New York’s Managed Care Reform Act. This Act, enacted in 1996, instituted standards for all managed-care plans, standardized grievance and appeals procedures, and established requirements for providing all enrollees and potential employees with detailed descriptions of managed-care plan’s benefits and coverage. Additional protections were put in place in 2007.

The legislation, passed during the 2009 legislative session, supplements the previous efforts to protect consumers in four ways. First, the law ensures that patients have timely access to home care services upon discharge from the hospital by requiring insurers to approve services more quickly. Non-managed care policies will be required to offer grievance procedures, access to specialty care through referrals, and transitional care consistent with that offered through managed-care contacts. In addition, the appeals process will be simplified in instances for coverage of rare diseases. The law will also modify how insurers issue dividends and/or credits to policyholders when appropriate.

“Health insurers need restrictions so that New Yorkers can access their health care plans when needed the most. Often people may be left out in the cold when their health insurance plan doesn’t cover a rare disease or approve home care services quickly. We cannot let that tradition continue,” said Galef. “Consumers will be further protected from health insurance companies in these instances.”

In addition, this law will help health care providers. It ensures prompt processing and payment of health care claims and authorized the superintendent of insurance to issue regulations regarding electronic claims filing, requiring insurers to pay within 30 days for claims transmitted via the internet or e-mail and require providers to submit claims within 120 days of date of service. The law further requires that insurers inform them about any adverse reimbursement charges and allow them an opportunity to opt out of the contract. The measure also prohibits services provided in a participating medical facility from being deemed out-of-network because a provider was not a participating physician and authorized health plans and providers and hospitals to agree to alternative dispute resolutions if possible.

“This new law will ensure that health insurance companies will no longer be able to take advantage of consumers in these situations. This measure allows patients and providers to concentrate on personal health needs rather than bureaucracy and red tape. I will continue working in the Assembly to make sure that health insurers provide services and respond quickly to the needs of the citizens of New York,” concluded Galef.